NOTE: This Pre-Arrangement Guide is intended merely as a worksheet to present items that need consideration during the pre-planning process - no values or preferences indicated on the form here in Step 1 will be submitted or recorded in any way. Only the information provided on the form in Step 3 will be submitted.

Have I ever been responsible for making funeral arrangements?YesNo

Today, I would expect my funeral to cost $

In five years I would expect to pay $

for that same funeral.

In ten years I would expect to pay $

for that same funeral.

In the event of my death, who would be responsible for making the arrangements?My spouseMy son or daughterMore than one of my childrenA good friend or neighborOne or both of my parentsI'm not sure

The funeral I want would include:A copper or bronze casketA hardwood casketA steel casketCremation with a memorial serviceVisitation for friends and relativesA traditional service or a personalized remembranceI'm not sure

The money needed to pay for my funeral would come from:My life insuranceMy savingsMy family's savingsA bank loan taken out by my spouse or familyI'm not sure

If my death occurred tomorrow, what I would regret most regarding my final arrangements would be:The emotional burden it would place on my survivorsNo one would know what I wanted for myself or for my loved onesThe financial strain it would cause my survivorsThe possibility of emotional overspendingThe potential for disagreements among by survivors over what to doThat I had not taken care of it myself ahead of time

Step 2

Pre-Arranging gives you peace of mind and saves you money...

Most families we serve are comforted by the knowledge that their loved ones will be spared the hardship of making decisions at such a difficult and sensitive time. In addition, pre-planning allows for pre-financing. Since funeral costs are subject to escalating inflation, pre-planning can save you a considerable amount by freezing funeral expenses at today's prices.

The following graph represents how inflation will affect the cost of a funeral over a 15-year period.

Ask us how you can safeguard your estate and protect your assets through pre-planning. We'll be happy to discuss the details with you.

THE CHOICE IS YOURS

You can make these decisions before a death occurs

You can wait until a life altering event forces you to make them

Step 3

Online Pre-Arrangement Form:

There are numerous benefits to pre-arranging a funeral, some of which include:

Provides peace of mind

Relieves your loved ones of unnecessary concern

Reflects your expressed wishes

Alleviates financial burden on your family

Please take a few minutes to fill out the Online Pre-Arrangement form below. Once the information is submitted, a La Paloma Funeral Services representative will review and file it and will be in touch with you to further discuss the details of your arrangements.

Information About the Person Completing this Form:

First Name:

Middle Name:

Last Name:

Email:

Street Address:

City:

County:

State:

Zip:

Phone:

Person for Whom I Am Pre-arranging:

Vital Information About the Person for Whom Pre-arranging Is Being Done:

Last Name:

First Name:

Middle Name:

Sex:

Marital Status:

Social Security #:

DOB:

Place of Birth:

Spouse's Full Name:

Spouse's Maiden Name:

Place of Marriage:

Date of Marriage:

Father's Full Name:

Mother's Name:

Mother's Maiden Name:

Work and Education:

Education:

Usual occupation (most of life):

Kind of Business:

Company:

Military Records:

Branch of Service:

Serial Number:

Date of Enlistment:

Rank at Discharge:

Date Discharged:

Discharge on file at:

Copy of discharge papers:

YesNo

Name(s) of War(s)/Conflict(s) Toured:

Funeral Service Information

Place of Service:

Name of Funeral Home:

Address:

Phone:

Place of Visitation:

I Prefer the Funeral Service To Be:

Viewing for Family:

YesNo

Viewing for Friends:

YesNo

Religious Denomination:

Place of Worship:

Lodge / Union:

Person(s) To Finalize Arrangements At Time of Death:

Check here and skip this section if the person filling out this online form is also the person making the final arrangements.

Full Name:

Street Address:

City:

County:

State:

Zip Code:

Phone:

Special Instructions

Flower Preference:

Music:

Casket Bearers (x6):

1.
2.
3.
4.
5.
6.

Jewelry:

Glasses:

Clothing:

Other:

Disposition Options:

I Prefer:

Cemetery:

Address:

Phone:

Section:

I Have Made A Last Will And Testament:

YesNo

Other Information & Instructions:

Please list any other instruction or information you would like us to have:

Memorials & Charities:

Please list any memorials or donations to charity that you would like to declare:

Options:

Please select one of the options below:

Send Information About Pre-ArrangementContact Me To Set An AppointmentPlease Keep My Information On File